难治性乳糜尿需手术治疗1例报告。

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-05-12 eCollection Date: 2025-06-01 DOI:10.1097/MS9.0000000000003323
Uttam Chaulagain, Kapil Khanal, Kailash Mani Pokhrel, Nischal Shrestha, Urusha Naaz
{"title":"难治性乳糜尿需手术治疗1例报告。","authors":"Uttam Chaulagain, Kapil Khanal, Kailash Mani Pokhrel, Nischal Shrestha, Urusha Naaz","doi":"10.1097/MS9.0000000000003323","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Chyluria is a rare condition characterized by milky urine usually occurring due to rupture of lymphatic channels into the urinary system. Common symptoms include milky urine, clot colic, urinary retention, weight loss, edema, etc. Diagnosis is based on clinical suspicion, laboratory tests and imaging techniques such as USG, CT, MRI, and lymphangioscintigraphy. Management is based on dietary modifications, pharmacological treatment, minimally invasive endoscopic sclerotherapy, and laparoscopic chylolymphatic disconnection. Other procedures such as lymphovenous anastomosis or simple nephrectomy can also be adapted.</p><p><strong>Case description: </strong>A 33-year-old female from a filariasis endemic region of Nepal presented with chief complaints of whitish urine for 15 months associated with weight loss. The patient was initially treated with diethylcarbamazine (DEC) for 21 days, a year ago with some dietary modifications. She also underwent two episodes of endoscopic sclerosant instillations. The immunochromatographic test for filariasis was positive. Milky efflux was seen from the left ureteric orifice. Retrograde pyelography showed lymphatic backflow. The patient was managed with laparoscopic left chylolymphatic disconnection (Hilar stripping and nephron lympholysis), and the symptoms resolved.</p><p><strong>Discussion: </strong>Refractory cases of chyluria require surgical intervention to prevent long-term morbidity. Traditional open surgical ligation and excision of renal pedicle lymphatics are replaced by the minimally invasive approach of retroperitoneoscopy. The laparoscopic method is a preferred treatment as it has minimal incision-related morbidity and is safe, effective, and efficient. Other surgical options include lymphovenous anastomosis or renal autotransplantation.</p><p><strong>Conclusion: </strong>This case highlights the success of surgical intervention in treating refractory chyluria. Chylolymphatic disconnection could be safely performed with a laparoscopic approach without significant complications and reoccurrence.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3945-3948"},"PeriodicalIF":1.7000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140728/pdf/","citationCount":"0","resultStr":"{\"title\":\"Refractory chyluria warranting surgical managementa case report.\",\"authors\":\"Uttam Chaulagain, Kapil Khanal, Kailash Mani Pokhrel, Nischal Shrestha, Urusha Naaz\",\"doi\":\"10.1097/MS9.0000000000003323\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Chyluria is a rare condition characterized by milky urine usually occurring due to rupture of lymphatic channels into the urinary system. Common symptoms include milky urine, clot colic, urinary retention, weight loss, edema, etc. Diagnosis is based on clinical suspicion, laboratory tests and imaging techniques such as USG, CT, MRI, and lymphangioscintigraphy. Management is based on dietary modifications, pharmacological treatment, minimally invasive endoscopic sclerotherapy, and laparoscopic chylolymphatic disconnection. Other procedures such as lymphovenous anastomosis or simple nephrectomy can also be adapted.</p><p><strong>Case description: </strong>A 33-year-old female from a filariasis endemic region of Nepal presented with chief complaints of whitish urine for 15 months associated with weight loss. The patient was initially treated with diethylcarbamazine (DEC) for 21 days, a year ago with some dietary modifications. She also underwent two episodes of endoscopic sclerosant instillations. The immunochromatographic test for filariasis was positive. Milky efflux was seen from the left ureteric orifice. Retrograde pyelography showed lymphatic backflow. The patient was managed with laparoscopic left chylolymphatic disconnection (Hilar stripping and nephron lympholysis), and the symptoms resolved.</p><p><strong>Discussion: </strong>Refractory cases of chyluria require surgical intervention to prevent long-term morbidity. Traditional open surgical ligation and excision of renal pedicle lymphatics are replaced by the minimally invasive approach of retroperitoneoscopy. The laparoscopic method is a preferred treatment as it has minimal incision-related morbidity and is safe, effective, and efficient. Other surgical options include lymphovenous anastomosis or renal autotransplantation.</p><p><strong>Conclusion: </strong>This case highlights the success of surgical intervention in treating refractory chyluria. Chylolymphatic disconnection could be safely performed with a laparoscopic approach without significant complications and reoccurrence.</p>\",\"PeriodicalId\":8025,\"journal\":{\"name\":\"Annals of Medicine and Surgery\",\"volume\":\"87 6\",\"pages\":\"3945-3948\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-05-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140728/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Medicine and Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/MS9.0000000000003323\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Medicine and Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/MS9.0000000000003323","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

乳糜尿是一种罕见的疾病,其特征是乳白色的尿液,通常是由于进入泌尿系统的淋巴通道破裂而发生的。常见的症状有乳白色的尿、凝块绞痛、尿潴留、体重减轻、水肿等。诊断是基于临床怀疑、实验室检查和成像技术,如USG、CT、MRI和淋巴管显像。治疗的基础是饮食调整、药物治疗、微创内镜硬化疗法和腹腔镜乳糜淋巴切断术。其他手术如淋巴静脉吻合或单纯肾切除术也可以适应。病例描述:一名来自尼泊尔某丝虫病流行地区的33岁女性,主诉为尿白色15个月,伴有体重减轻。患者一年前开始使用二乙基卡马嗪(DEC)治疗21天,并对饮食进行了一些调整。她还接受了两次内镜下硬化剂注射。丝虫病免疫层析试验阳性。左侧输尿管口可见乳白色流出物。逆行肾盂造影显示淋巴回流。患者经腹腔镜左乳糜淋巴断开(Hilar剥离和肾元淋巴溶解)治疗,症状消失。讨论:顽固性乳糜尿需要手术干预,以防止长期发病率。传统的开放手术结扎和切除肾蒂淋巴管被后腹膜镜微创入路所取代。腹腔镜方法是一种首选的治疗方法,因为它具有最小的切口相关的发病率和安全,有效和高效。其他手术选择包括淋巴静脉吻合或肾脏自体移植。结论:本病例强调手术治疗难治性乳糜尿的成功。乳糜淋巴分离术可以在腹腔镜下安全地进行,没有明显的并发症和复发率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Refractory chyluria warranting surgical managementa case report.

Introduction: Chyluria is a rare condition characterized by milky urine usually occurring due to rupture of lymphatic channels into the urinary system. Common symptoms include milky urine, clot colic, urinary retention, weight loss, edema, etc. Diagnosis is based on clinical suspicion, laboratory tests and imaging techniques such as USG, CT, MRI, and lymphangioscintigraphy. Management is based on dietary modifications, pharmacological treatment, minimally invasive endoscopic sclerotherapy, and laparoscopic chylolymphatic disconnection. Other procedures such as lymphovenous anastomosis or simple nephrectomy can also be adapted.

Case description: A 33-year-old female from a filariasis endemic region of Nepal presented with chief complaints of whitish urine for 15 months associated with weight loss. The patient was initially treated with diethylcarbamazine (DEC) for 21 days, a year ago with some dietary modifications. She also underwent two episodes of endoscopic sclerosant instillations. The immunochromatographic test for filariasis was positive. Milky efflux was seen from the left ureteric orifice. Retrograde pyelography showed lymphatic backflow. The patient was managed with laparoscopic left chylolymphatic disconnection (Hilar stripping and nephron lympholysis), and the symptoms resolved.

Discussion: Refractory cases of chyluria require surgical intervention to prevent long-term morbidity. Traditional open surgical ligation and excision of renal pedicle lymphatics are replaced by the minimally invasive approach of retroperitoneoscopy. The laparoscopic method is a preferred treatment as it has minimal incision-related morbidity and is safe, effective, and efficient. Other surgical options include lymphovenous anastomosis or renal autotransplantation.

Conclusion: This case highlights the success of surgical intervention in treating refractory chyluria. Chylolymphatic disconnection could be safely performed with a laparoscopic approach without significant complications and reoccurrence.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
自引率
5.90%
发文量
1665
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信